Osteophyte-Related Rupture of a Scalp Tissue Expander - A Case Report and Literature Review

Background: Tissue expansion is a widely accepted technique in reconstructive surgery, especially in providing an excellent tissue match for scalp defects. However, it is associated with a variety of complications such as infection, expander exposure, implant failure, or flap necrosis, which may lead to reconstruction failure. Aim and Objectives: In this report, we present our experience using the tissue expansion technique to reconstruct a large scalp cicatricial alopecia and demonstrate the salvage procedures after expander failure caused by an unusual condition of multiple osteophyte formation. The relevant literature is also reviewed. Materials and Methods: A 45-year-old man presented a capillary malformation on the left temporoparietal scalp. He underwent complete excision without recurrence. The scalp tissue expansion was planned to reconstruct the cicatricial alopecia 7 months later. However, the expander deflated at a late stage of the expansion. The expanded flap was not large enough for reconstruction because of an unusual condition of multiple osteophyte formation beneath the expander, which resulted in its deflation. Subsequent serial excisions of the alopecia defect and local flap reconstruction were performed, and finally, successful reconstruction was achieved. Results: The patient regained natural looking hair distribution and was satisfied with the aesthetic result of the reconstructed scalp. Conclusions: Tissue expansion is a powerful tool for cicatricial alopecia reconstruction. Osteophyte formation is a rare condition resulting from tissue expansion. We suggest a hard base tissue expander to prevent the unusual complication.